Tamoxifen and Cymbalta and/or Trintellix

Hi, I am having the same dilemma. I have taken Prozac for years and was told that it interferes with Tamoxifen. The Prozac has worked well for me and I was able to keep my depression at bay. I then started Zoloft when I started Tamoxifen and have been on that for a while, it is not working and I am actually weaning off it.

I finally went to a Psychiatrist who recommended Effexor. I will start taking it on Thursday this week. I really hope it works. Effexor, Celexa and Lexapro are the anti depressants that do not interfere with Tamoxifen. I am not a psychiatrist but maybe you should think about making an appointment.

Right now I feel like I am on the psychotropic rollercoaster. My husband is wondering where his kind and loving wife is. I get terribly nasty, evil and depressed when on an anti depressant that doesn't work. I could end up down that deep rabbit hole and never come back out. Good Luck, and I hope all works out well for you.

If you look at my profile, I recently posted a question similar to yours and received a lot of feedback from the helpful women on this site.

Hey All, I am on Trintellix with no issues and my oncologist checked to make sure it was all good to take with the Tamoxifen. I take it at bed time and the Tamoxifen in the am.

Trintellix is like Celixa, if I am remembering correctly the same company makes it.

It's also fairly new within the last 5 years I believe which could be why there is not a lot on the net about it.

Hi Nattykat1968,

I am making the switch right now from Prozac to Lexapro because eventually I will be on Tamoxifen (after chemo and rads). Wanted to make the change now, before I start chemo to try and limit multiple side effects happening at same time. I think it really stinks that on top of all this we have to worry about our anti-depressants. One thing I can share - while I've been on anti-depressants for many, many years, it's only in the past few that I've actually had a psychiatrist who seems to really know what he's doing. It's been a life changer. Definitely talk to your psychiatrist and also keep your eyes open for recommendations if you don't feel like you can really rely on your current psychiatrist. (I know - like the last thing you need right now is to have to find another doctor). You are not alone! I wish you luck in your med change.

I switched from Wellbutrin to Lexapro to go on tamoxifen. It was alright but in the end I couldn't tolerate the tamoxifen anyway. My doctor agreed to let me try toremifene (Fareston) - a different SERM in the same class as tamoxifen that has a lot of research for stage 4 and some evidence for efficacy for premenopausal women for preventing recurrence, but isn't FDA approved for that purpose in the USA.

The mechanism that makes tamoxifen less effective with certain drugs is somehow related to a genetic trait that is a lot more common in Asia. So there are a lot more Chinese studies looking at toremifene as an alternative. I also found some western articles that it should be considered a valid second choice drug for women who cannot tolerate tamoxifen, including for the reason of being on an antidepressant that interferes with it.

I was glad to go back on Wellbutrin and the toremifene is working out fine, much better side effects profile for me than tamoxifen.

Thanks for making that connection! I'm not always good at connecting user names across thread.

I haven't had any issues at all with 'finding' toremifene. My insurance requires me to use a particular mail order pharmacy (Express Scripts) for maintenance meds, and there was nothing to indicate that availability would be an issue.

My doctor did warn me that it might be a fight to get insurance to cover it because of the off label use. She said she would have that fight if necessary. But it was also not an issue. I'm not sure how much of that was due to them seeing that I had tried like four different brands and multiple doses of tamoxifen over the prior year.

Side effects wise, toremifene has been much better for me than tamoxifen. Even though all my tamoxifen side effects (except the 'sedation') went away with time or pharmaceutical help, there was still some unpleasantness along the way. (The heartburn in particular was pretty brutal for a while). My side effects with toremifene are so mild that I'm not even 100% sure they're due to the drug - I think I'm somewhat more thirsty/dizzy, somewhat more sensitive to heartburn (still taking antacids but only as needed), and that's maybe it. I can easily see staying on it for 5 years, 10 years, whatever.

It is such a huge relief. I am just getting to the bottom of my first 3 month supply of toremifene - after never having gotten there with any of the tamoxifen brands I tried - and I'm so grateful for it and that my doc let me try it.

I hope that you can get some useful medical guidance and figure out what's best for you. It sounds like a really ambiguous and confusing situation!

With my insurance covering it, there was no cost difference between the toremifene and the tamoxifen.

Toremifene is the generic (the brand name is Fareston).

I did look it up just in case insurance did not cover it. . I use the website GoodRx for this - it's super useful was a godsend when I didn't have prescription drug coverage.

It's horrifying how much more expensive generic toremifene is than generic tamoxifen. The cheapest price I see for a 90 supply is Walmart for $1,244! The name brand would be over $3,700! I have no idea how they get away with this, but I know our health care system is deeply broken.

If my insurance didn't cover it, I would explore ordering it from an international mail order pharmacy. There are issues with these but I'd do my research and find the most reputable seeming one (years ago I used planetdrugsdirect). I am seeing a 90 supply online for around $200. Which is still a lot. But not insane.

Edited to add: I also just found this: https://prescriptionhope.com/fareston-toremifene/ It says it brings it down to $50 per month.

Thanks Salamandra. It's insane that the GENERIC costs that much. Since I told my MO I wouldn't be trying this until after my next surgery, I am hoping to have a several month break from her pressure and then we can re-set things. If I don't get an answer on the pathology I'm going to ask my social worker (seems to have the same role as a nurse navigator at other hospitals) to follow up.

hi have faith, I’ve been through a bunch of different antidepressant switches in the past. My guess is that you are tapering down the Celexa and tapering up on the Effexor, so you haven’t yet reached the therapeutic dose of Effexor yet. Even once you reach the therapeutic dose you need to give it time to build up in your system before feeling good. So try to hold out a bit. You could also ask your doc about an add on boost drug to help with your mood, there are many drugs that are used off label for this. In the interim I hope you have a therapist to help manage the depression while you’re waiting for the drugs to kick in. I’ve been where you are and am sending hugs.